Compare Bupa and NIB
When comparing health funds, it pays to look through some of the finer details. Here are some statistics from the Private Health Insurance Ombudsman State of the Health Funds Report 2024–25 to keep in mind when comparing Bupa and NIB Group.
1 For services provided through Medical Gap Schemes, Bupa covered 97.8% of medical services with no gap or known gap vs 95.3% covered by NIB from 2024 to 2025.
2 For the treatment of private patients in a hospital, Bupa covered 89% of hospital related charges vs 85.8% covered by NIB from 2024 to 2025.
3 Bupa returned 82.4% of contributions it received back to members as benefits, vs 82% of contributions returned to NIB members as benefits from 2024 to 2025.
All statistics shown are as outlined in the Private Health Insurance Ombudsman State of the Health Funds Report 2024–25, which summarises the average coverage of each insurer’s policies across Australia.
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Here are our top tips for comparing covers.
Each level of hospital cover includes a different number of included services (also known as clinical categories). The higher your cover, the more services are included. Hospital cover is standardised by a set of tiers that can help you compare similar levels of cover across health insurers.
To choose the services you need cover for, make a list of your pre-existing or genetic conditions, lifestyle (e.g. sport and hobbies), and future plans like growing your family. If you’re unsure, researching common health concerns for your age group is a good place to start.
An excess is a one-off payment made when a policy member is admitted to hospital. The excess applies once per person, per calendar year. Depending on the health insurer, you may be able to choose a higher hospital excess in return for a lower premium.
If you consider yourself to be fairly healthy, a higher excess can be a good option to keep your premiums down.
Many health insurers have special agreements in place with select hospitals and specialists to reduce out-of-pocket costs for members. If you have a preference for a particular hospital or specialist, it’s worth researching which health insurers they have agreements with.
The Bupa Medical Gap Scheme helps reduce your medical costs for treatment when you’re admitted to hospital. If your specialist takes part in our scheme and chooses to use it for your treatment, you’ll never pay more than $500 per doctor. Use the Find a Provider tool to check if your specialists are part of the network.
Look for cover that includes services that match your lifestyle and health needs. For example, do you need a new pair of glasses or contacts every year? Do you play sports that might increase your risk of needing physio? Having a list of services that are important to you can help you shortlist cover options.
Extras services have limits (the total amount you can claim on a service). At Bupa, there are three different types of limits that can apply to an extras service:
A yearly limit (sometimes referred to as an ‘annual maximum’) is the total amount you can claim on a service in a calendar year. Yearly limits generally reset each year on 1 January.
A combined yearly limit is a shared yearly limit across multiple extras services. Combined yearly limits generally reset each year on 1 January.
A lifetime limit is the total amount you can claim on a service in your lifetime.
Generally the higher your extras cover, the higher your limits. When comparing covers, keep an eye out for the limits on services you use regularly. For example, if you visit the physio regularly you’ll want to look for a cover that has high yearly limits for physiotherapy.
A benefit is the amount you get back when you claim on a covered service, up to limits. The benefit will be either a set dollar amount, or a percentage back. Generally the higher your extras cover, the higher your benefits.
You could get 50% or more back on selected extras services at Members First provider, up to yearly limits.^ Use the Find a Provider tool to check if your providers are part of the network.
Always read the Policy Information when choosing hospital or extras cover.
^ Percentage back may vary depending on your level of cover, and benefit claiming restrictions. For most services at our Members First providers covering dental, physiotherapy, chiropractic and podiatry consultations. Bupa has Members First providers for these services. Not available in all areas. Waiting periods, yearly limits, policy and fund rules apply. Applies to included services only.
# When switching to Bupa on an equivalent or lower level of cover within 60 days of cover end date with old health fund, provided you already served your waiting period.